An issue you’ll have to address at some point is when you should start
HIV treatment.

In most
cases, it’s currently recommended in UK HIV treatment guidelines that you start
taking HIV treatment when your CD4 cell count is around 350. Your doctor
should start discussing HIV treatment with you when your CD4 cell count is
around this figure and you are advised to start treatment as soon as you are
ready.

If you
are ill because of HIV, or you have had an AIDS-defining illness.

If you
also have hepatitis B or hepatitis C (often called co-infection).

If you
would like to be on HIV treatment to reduce the risk of passing on HIV.

Taking
antiretroviral therapy is a long-term commitment. At present, once you start
the drugs, you are likely to be on them for the rest of your life. Feeling
ready to start treatment is a good step towards taking your treatment in the
right way, at the right times.

NAM’s online tool Get
set for HIV treatment can help you think through the practical and emotional
aspects of starting HIV treatment.

Recently infected with HIV?

The
six-month period after you are infected by HIV is called primary HIV
infection. There is currently no clear evidence that taking treatment at this
time will mean that you live a longer, healthier life. Some doctors believe,
however, that taking treatment during this period may offer a unique chance to avoid
damage to your immune system, especially as people have a very high viral load
during this period.

If you are
considering treatment during the period soon after infection, you should start
as soon as possible, ideally within 12 weeks of infection with HIV. A very
small number of people become quite ill during primary infection with HIV. This
is often called 'seroconversion illness'. It’s possible that people who have
more serious symptoms may benefit most from a course of treatment at this stage
(around 48 weeks).

The
potential benefits of taking treatment at this time need to be weighed up
against the impact of starting HIV treatment. You may still be coming to terms
with your HIV diagnosis, and not feel ready to start treatment. There is also the possibility
of side-effects – treatment may reduce your quality of life
at a time when HIV would not have. If your treatment doesn’t work effectively
against HIV or you don’t take it in the right way, it’s possible drug
resistance could develop. This could mean you have fewer drug options later.

It is
recommended that you start HIV treatment during primary infection if:

You
have an AIDS-defining illness.

You
have a neurological condition (one that affects the brain) connected with HIV.

Your CD4
cell count is below 350.

You are
worried about passing on HIV to others.

However, most people do not find out that they
have HIV until months or years after infection.

Infected with HIV for over six months, but without symptoms?

Current HIV
treatment guidelines in the UK
recommend that treatment should be started when your CD4 cell count is around
350. Starting treatment at this time will reduce your risk of becoming
ill because of HIV, as well as of developing some other serious illnesses as
well.

You are
recommended to start treatment earlier (when your CD4 cell count is around 500),
if you also have hepatitis C or hepatitis B, as liver disease becomes worse
when the CD4 cell count is lower. There's a lot more information on hepatitis
in the section Non-HIV-related illnesses - hepatitis.

It may also
be a good idea to start treatment at a higher CD4 cell count if you have a higher
risk of kidney or heart disease.

You can sometimes start treatment with a CD4 cell count above 350 if
you would like to do so to reduce the possibility of passing HIV on to your
partner. Talk to your HIV doctor about this.

Infected with HIV for over six months, and ill because of HIV?

Regardless
of your CD4 cell count, doctors recommend that you start HIV treatment if you
are becoming ill because of HIV, or if you have another serious illness, such
as HIV-related kidney disease, heart disease or HIV-related neurocognitive
(brain) illnesses. It is also recommended you start HIV treatment if you are
receiving treatment for cancer and, in some cases, if you are receiving
treatment for hepatitis B.

The exact
timing of when you start HIV treatment might depend on what treatment you need
for the other condition and the state of your health.

For example, if you also have tuberculosis (TB),
the timing of your treatment will probably depend on your CD4 cell count. There
are potential interactions between anti-HIV drugs and a key medicine used to
treat TB. Because of this, many doctors recommend delaying treatment with
anti-HIV drugs until you have been on TB treatment for at least two months. However,
you may need to start HIV treatment sooner – often within two weeks of starting
TB therapy – if your CD4 cell count is very low. Similarly, if you become ill
with TB when you are already on HIV treatment, you may be recommended to stop
taking anti-HIV drugs for the first two months of tuberculosis treatment. There's a lot more
information on TB in the section Symptoms and illnesses – TB.

Diagnosed with HIV when your CD4 cell count is already low?

If your
CD4 cell count is below 200, your doctor will recommend starting HIV
treatment very soon (ideally within two weeks). This is because you have a risk
of developing serious – and potentially life-threatening – illnesses when your
CD4 count is this low.

You
may also need to take small doses of antibiotics (a treatment called
prophylaxis) to prevent you developing some infections. These are often called
opportunistic infections [HIV-related illnesses]. Once your CD4 cell count has
increased to above 200, you will stop taking the prophylaxis. If you are
already ill with an opportunistic infection, you usually will start treatment
for this before you start HIV treatment.

Although you may need some additional treatment
and monitoring, there is a good chance that you will respond well to treatment
and your immune system will start to recover.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.